CRH Founder Is a Mover and Shaker in Rural Healthcare

By Brenda Haugen on
July 13, 2018July 16, 2018

Kevin Fickenscher, MD

Kevin Fickenscher, MD, likes to stir things up. But he
wears a small whisk on his lapel to remind himself of the
fine line between stirring too much and stirring too
little. An avid cook, Fickenscher realizes that if you
stir too much, you make a mess. If you stir too slow, you
don't bring the ingredients successfully together. The
whisk analogy fits almost any area in life.

"You have to stir just right," he said. "It's been my
symbol for 25 years."

Fickenscher's roots at UND run deep. He first came to the
University as a student in 1970. He knew he wanted to be
a doctor, but he initially went into psychology because
his advisor told him he should think about what would
happen if he didn't get into medical school.

I had a number of detractors who didn't think I would
quite make it, including my high school biology teacher,
who was the first person I called when I got accepted (to
medical school).

"I had a number of detractors who didn't think I would
quite make it, including my high school biology teacher,
who was the first person I called when I got accepted (to
medical school)," Fickenscher recalled with a smile.

As an undergraduate, Fickenscher quickly became deeply
involved in many activities. "I was always sort of a
community activist type," he said.

When a measles outbreak struck campus, Fickenscher
organized students for a measles immunization program.
That led to the creation of CHIP—Council for Health
Interdisciplinary Participation. At the time, UND
nursing, medical school, and social work students were
all very separate, with little communication among the
various disciplines. Through CHIP, health sciences
students began collaborating on projects.

During medical school, Fickenscher took a year off when
he was elected president of the American Medical Student
Association. During his presidency, he lived in
Chicago and even had the opportunity to testify before
Congress. Fickenscher advocated for renewal of the
National Health Service
Corps and for changes in the medical education
curriculum to be more inclusive of clinical experiences
as well as basic sciences.

In addition, he visited all the major pharmaceutical
companies. Students at the time were having strong
philosophical differences with pharmaceutical industry,
which was using prisoners for drug tests, Fickenscher
explained.

"We really felt that that was inappropriate," he said.

After graduating from medical school at UND in 1978,
Fickenscher was accepted into the
Residency Program in Social Medicine (RPSM) in New
York City as a family practice graduate. It was an
eye-opening experience.

"It taught us about the social dimensions of disease as
well as the clinical and physical dimensions," he said.

As part of his first week as a resident, the RPSM had
Fickenscher apply for food stamps, which he described as
a "hellacious experience."

"I learned a lot about what my patients had to go
through," he said. "And that was the intent of the
program."

When Fickenscher had an opportunity to be chief resident,
UND Medical School Dean Tom Johnson came to see him in
New York. Johnson asked Fickenscher to come home. Johnson
had secured funding for a program in rural health and
needed someone to run it. He wanted that someone to be
Fickenscher.

To me it seemed like the ultimate social medicine project
because I was going to be coming back home, and I was
given this very broad charge of 'solve rural health
problems.'

"To me it seemed like the ultimate social medicine
project because I was going to be coming back home, and I
was given this very broad charge of 'solve rural health
problems,'" Fickenscher said.

When the Rural Health Program started in 1980, it had a
$73,000 budget and Fickenscher was the only employee. On
his first day, Fickenscher went to Dean's Office in what
is now Columbia Hall and asked Johnson where he should
go. Johnson told him he thought there was some empty
space on the second floor. So Fickenscher went to the
second floor and picked an office. He quickly returned to
the Dean's Office because he didn't even have a desk.
Johnson said he thought there was some surplus furniture
and equipment in the basement.

"So I got an old [IBM] Selectric typewriter and started
the Rural Health Program," Fickenscher said.

From the very start, Fickenscher didn't want what was to
become the CRH to be a traditional academic research
program.

I wanted us to help the people of North Dakota. So we
were going to help make healthcare better. That was my
overriding philosophy.

"I wanted us to help the people of North Dakota," he
said. "So we were going to help make healthcare better.
That was my overriding philosophy."

He didn't know exactly what that meant, so he visited
physicians in rural North Dakota. He also reached out to
legislators across the state. He asked all of them what
they wanted his office to do.

"The clear message was if you sit in Grand Forks, you're
not going to help us. So don't sit in Grand Forks,"
Fickenscher said.

So Fickenscher went to work traveling the state. The CRH
worked with rural hospitals to help them find ways to
continue developing and sustaining healthcare services
for area residents. It also looked at workforce issues
and became involved in a successful, albeit unusual,
physician recruitment program.

"We had some slightly different approaches," Fickenscher
said with a chuckle. "For example, our recruiters had a
contest for a couple of docs to see if they could get
them married off locally so that after we recruited them
we could keep them. So we did things like that. It was a
lot of fun."

Because of the work going on in North Dakota, several of
the surrounding states reached out to the program, giving
the CRH a more regional focus. When Fickenscher moved on
from the CRH after nine years with the program, it
included 15 staff members, a $1.8 million budget, and a
number of projects. Through the years, the CRH has
continued to grow, and Fickenscher has been pleased to
see the Center's mission continue.

I'm really proud of what the Center has become. It's very
exciting to come back and see what folks have
accomplished and are accomplishing. It's very satisfying
to see that. And the core philosophy around making
healthcare better still exists.

"I'm really proud of what the Center has become,"
Fickenscher said. "It's very exciting to come back and
see what folks have accomplished and are accomplishing.
It's very satisfying to see that. And the core philosophy
around making healthcare better still exists."

He's also excited to see what the future holds in rural
health and believes rural America is going to be in the
forefront in using virtual technologies in healthcare.

"I really believe that all of healthcare is being
challenged in some really profound ways with new
technologies that are evolving, that are replacing the
entire tradition, if you will, of how we take care of
people," he said. "Specifically, I believe, we're getting
into an era where the use of virtual technologies is
becoming increasingly important as a modality and as a
very important component of the overall delivery of care
that didn't exist 20 years ago.